Associations between Social Determinants of Health and Threats to Interpersonal Safety Among African Americans Living in the Rural South

Background and Purpose

Prior research has linked the social determinants of health to increased risk for interpersonal violence. However, little is known about how the social determinants of health contribute to the risk for interpersonal violence among African Americans living in the rural South. African Americans experience higher rates of interpersonal violence compared to other groups because of structural inequality that results in greater proportions of African Americans living in poverty. Rural communities face increased risk of interpersonal violence due to social isolation, lack of resources, and poor system responses. The intersection of rurality, racial identity, and economic hardship makes this population particularly vulnerable to interpersonal violence. The purpose of this study is to explore associations between social determinants of health (food insecurity, housing instability, and transportation problems) and threats to interpersonal safety among African Americans living in rural Alabama. We hypothesize that individuals experiencing food insecurity, transportation problems, and housing instability will experience greater threats to interpersonal safety.

Methods

This study used a cross-sectional research design. Data was collected from 182 participants at two sites in rural Alabama from September 2019 to February 2020. Ninety eight percent of the sample identified as African American. Threats to Interpersonal safety were measured with four items: how often does anyone, including family: 1) physically hurt you; 2) insult or talk down to you; 3) threaten you with harm; and 4) scream or curse at you? (range = 0-16; Cronbach’s alpha=0.664). Higher scores indicate greater threats to interpersonal safety. Univariate analyses were conducted to describe sociodemographic characteristics, social determinants of health, and threats to interpersonal safety. Bivariate analyses were employed to examine the unadjusted relationship between threats to interpersonal safety, sociodemographic characteristics, and social determinants of health. Lastly, multiple linear regression was used to examine the factors associated with threats to interpersonal safety.

Results

The average threats to interpersonal safety were 1.91/10 (SD = 2.61). Food insecurity was positively associated with threats to interpersonal safety (β = 0.21, SE = 0.59, p < 0.05). Lack of transportation for daily living was positively related to threats to interpersonal safety (β = 0.26, SE = 0.96, p < 0.05), while lack of transportation to medical care was negatively associated with threats to interpersonal safety (β =-0.45, SE = 1.00, p < .01). Participants who reported worrying about stable housing tended to have higher threats to interpersonal safety (β = 0.20, SE = 0.87, p < 0.05) and participants who went to church more than 4 times a year appeared to have lower threats to interpersonal safety (β = -0.25, SE = 0.44, p < 0.01).

Conclusion and Implications

Individuals experiencing transportation problems for daily living, food insecurity, and housing instability experienced greater threats to interpersonal safety. Individuals experiencing economic hardship may rely on abusive friends, family members, or partners for needed resources. Violence prevention policies should address the social determinants of health particularly in the rural South, which is home to some of the poorest, under-resourced counties in the U.S.